Anyone in here handle medical billing?
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Not to mention, I have a $100 bill from my urgent care just for showing up and them telling me they can't help me 🙃🙃 so im looking at over $1300 just because my child broke my toenail 🙃
@Kapp💕 I haven't gotten around to it yet, I don't have much time to be able to make calls 😅 but I was also seeing if anyone had any input before I call as well to make sure I had ground to stand on, I have really bad social anxiety so I always freeze when I need to make calls like this 😅
Medical Biller of 5 years here! I primarily work physician (Part B) billing. I do not handle specific hospital billing (Part A) billing. But I did work for a call center for a bit regarding some hospital billing questions. Hospital charges in the US will almost always incur 2 different bills for things like hospital charges and some radiology and lab charges. The reason for this is because there are 2 different components. The facility portion which is the technical side of things. Such as taking blood, the fees to run a MRI etc. Then there is the professional charge. So basically the provider that sees you/reads any diagnostic tests etc. These look like two different bills for the same service but are considered valid in the medical billing industry. I believe most billing departments call this split/shared billing. Not sure which cms jurisdiction you are in/insurance you have. But most insurances follow CMS guidelines. I'll add another comment with more information
Below is some additional information from Novitas regarding this. https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00081589 Just indicate that you are a provider and part B on the pop up and it'll let you read the article. I hope this helps, but either way, I would contact the hospital/your insurance to ensure proper billing procedures were followed.
@Cassie I didn't have any sort of radiology or labs done, they were going to do an xray but it wasn't necessary so I didn't get one. I'm unsure what cms is, but I have cigna insurance if that helps.
Sorry, I was trying to provide additional examples. I apologize if I caused confusion. The facility/technical charge in this case would be the room etc. Specifically the second EOB you shared above. The professional charge is the actual physician that cared for you. It's dumb, but they will charge even for a 5 minute conversation. In this case that's the first EOB you shared above. Cigna I believe does follow CMS (Centers for Medicare Services) guidelines. Basically the Medicare policies but give me a few minutes and I'll see if I can locate a Cigna policy specifically. (Sometimes I can and sometimes I cant)
I checked Cignas website for a policy but couldn't find one. You can try to call the cigna customer service department and ask them for a copy of their policy or if they follow the Medicare (CMS) guidelines. I also contact the hospital directly for larger bills and have received prompt pay discounts in the past. Those can help bring the cost down as well
Bless the nhs for us here in the Uk because this is mind boggling!
@Cassie thank you for looking into it!! I'm going to call the billing department for an itemized list of what I was billed for, I still think it's weird as hell I was billed twice.
@Roxy I don't understand it! My husband pays a ton for our insurance every month!
That is actually so sad and takes the piss! I hope yu sort it out 😢 (and I hope yur baby is okay!) xx
Yeah, one is the facility charge the other is the physician charge. I’d contact the hospital and inquire about financial assistance; even if you think you make too much income, it’s surprising that you can still get a percentage off. Doesn’t hurt to apply!
It is weird the bills were issued twice, all list the same date, and two items are both "emergency room" but with a different severity listed. I'd call and ask if maybe there was a mistake
@Ella that's what I was thinking too, I wouldn't consider my toenail to be "high severity" lol
The first two pictures are from my insurance app and the second set of pictures are the EOB